Imperial College London
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Professor Anthony Gordon

Faculty of Medicine, Department of Surgery & Cancer

Chair in Anaesthesia and Critical Care
 
 
 
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Contact

 

anthony.gordon

 
 
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Location

 

ICUQueen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Mouncey:2021:10.3310/hta25140,
author = {Mouncey, PR and Richards-Belle, A and Thomas, K and Harrison, DA and Sadique, MZ and Grieve, RD and Camsooksai, J and Darnell, R and Gordon, AC and Henry, D and Hudson, N and Mason, AJ and Saull, M and Whitman, C and Young, JD and Lamontagne, F and Rowan, KM},
doi = {10.3310/hta25140},
journal = {Health Technology Assessment},
pages = {I--114},
title = {Reduced exposure to vasopressors through permissive hypotension to reduce mortality in critically ill peoble aged 65 and over; the 65 RCT},
url = {http://dx.doi.org/10.3310/hta25140},
volume = {25},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background:Vasopressors are administered to critical care patients to avoid hypotension, which is associated with myocardial injury, kidney injury and death. However, they work by causing vasoconstriction, which may reduce blood flow and cause other adverse effects. A mean arterial pressure target typically guides administration. An individual patient data meta-analysis (Lamontagne F, Day AG, Meade MO, Cook DJ, Guyatt GH, Hylands M, et al. Pooled analysis of higher versus lower blood pressure targets for vasopressor therapy septic and vasodilatory shock. Intensive Care Med 2018;44:12–21) suggested that greater exposure, through higher mean arterial pressure targets, may increase risk of death in older patients.Objective:To estimate the clinical effectiveness and cost-effectiveness of reduced vasopressor exposure through permissive hypotension (i.e. a lower mean arterial pressure target of 60–65 mmHg) in older critically ill patients.DesignA pragmatic, randomised clinical trial with integrated economic evaluation.SettingSixty-five NHS adult general critical care units.ParticipantsCritically ill patients aged ≥ 65 years receiving vasopressors for vasodilatory hypotension.InterventionsIntervention – permissive hypotension (i.e. a mean arterial pressure target of 60–65 mmHg). Control (usual care) – a mean arterial pressure target at the treating clinician’s discretion.Main outcome measures:The primary clinical outcome was 90-day all-cause mortality. The primary cost-effectiveness outcome was 90-day incremental net monetary benefit. Secondary outcomes included receipt and duration of advanced respiratory and renal support, mortality at critical care and acute hospital discharge, and questionnaire assessment of cognitive decline and health-related quality of life at 90 days and 1 year.Results:Of 2600 patients randomised, 2463 (permissive hypotension, n = 1221; usual care, n = 1242) wer
AU  - Mouncey,PR
AU  - Richards-Belle,A
AU  - Thomas,K
AU  - Harrison,DA
AU  - Sadique,MZ
AU  - Grieve,RD
AU  - Camsooksai,J
AU  - Darnell,R
AU  - Gordon,AC
AU  - Henry,D
AU  - Hudson,N
AU  - Mason,AJ
AU  - Saull,M
AU  - Whitman,C
AU  - Young,JD
AU  - Lamontagne,F
AU  - Rowan,KM
DO  - 10.3310/hta25140
EP  - 114
PY  - 2021///
SN  - 1366-5278
SP  - 114
TI  - Reduced exposure to vasopressors through permissive hypotension to reduce mortality in critically ill peoble aged 65 and over; the 65 RCT
T2  - Health Technology Assessment
UR  - http://dx.doi.org/10.3310/hta25140
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000625306400001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - http://hdl.handle.net/10044/1/90446
VL  - 25
ER  -
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